| NPI | 1730343823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP 60262342) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101017600) |
| 207Q00000X Family Medicine (Licence: TX BP10034759) | |
| 207Q00000X Family Medicine (Licence: WA OP60262342) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2021-06-09 |